Provider Demographics
NPI:1194802363
Name:O'LEARY, JULIA CRADOCK (PHD)
Entity type:Individual
Prefix:
First Name:JULIA
Middle Name:CRADOCK
Last Name:O'LEARY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2550 DENALI ST
Mailing Address - Street 2:SUITE 1610
Mailing Address - City:ANCHORAGE
Mailing Address - State:AK
Mailing Address - Zip Code:99503-2736
Mailing Address - Country:US
Mailing Address - Phone:907-646-9820
Mailing Address - Fax:907-646-9831
Practice Address - Street 1:2550 DENALI ST
Practice Address - Street 2:SUITE 1610
Practice Address - City:ANCHORAGE
Practice Address - State:AK
Practice Address - Zip Code:99503-2736
Practice Address - Country:US
Practice Address - Phone:907-646-9820
Practice Address - Fax:907-646-9831
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AK513103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical